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S2.1 Gastrointestinal > Gastrointestinal Cancers > Flashcards

Gastrointestinal Cancers Flashcards

1
Q

What are the various types of cancers (with respect to organs) in the GI tract?

A 
Oesophageal cancer
Gastric cancer
Colorectal cancer
Cholangiocarcinoma
Hepatocellular carcinoma
Pancreatic carcinoma
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2
Q

What are the various prognoses (5YS) for each type of cancer?

A 
Oesophageal - <10%
Gastric - <20%
Colorectal - (stage B/C) 64-38% (D 3%)
Cholangiocarcinoma - no full data
Hepatocellular - no full data
Pancreatic carcinoma - inoperable 1% (<6m life expectancy), operable 15%
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3
Q

What histological type of gastric cancer is most common?

A

Adenocarcinoma

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4
Q

How do patients with gastric cancer present?

A 
Dyspepsia
Early satiety
Nausea/vomiting
Weight loss
GI bleed
Fe deficient anaemia
Gastric outlet obstruction
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5
Q

What are the risk factors for gastric cancer?

A

Diet
Genes
Smoking
H pylori

Family history
Previous gastric resection
Biliary reflux
Premalignant gastric pathology

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6
Q

What are the symptoms/signs for gastric cancer?

A 
Early satiety
Dyspepsia
Nausea/vomiting
Iron deficiency, anaemia
Gastric outlet obstruction
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7
Q

What are the alarm features for GI cancer?

A 
Anaemia
Loss of Weight
Anorexia
Recent onset of progressive symptoms
Malaena/haematemesis
Swallowing Difficulty
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8
Q

What investigations might be done in suspected gastric cancer?

A

Endoscopy
Contrast Meal
CT chest/Abdom for TNM

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9
Q

What is the process of managing suspected gastric cancer?

A

Endoscopy and biopsy for histological diagnosis.
Staging
MDT - fitness for treatment options
(surgical vs chemo)

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10
Q

What are the surgical options in gastric cancer?

A

Subtotal gastrectomy
Total gastrecyc and Roux en Y reconstruction
Laparoscopic distal gastrectomy
Open gastrectomy

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11
Q

What is the most common type of colorectal cancer?

A

95-98% adenocarcinoma

2/3rds colonic, 1/3rd rectal

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12
Q

What are the risk factors for colorectal cancer?

A

FH
IBD
Genetics
- FAP, HNPCC, Peutz-Jeghers

Most (85%) are sporadic

  • increased age
  • male
  • previous adenoma/CRC
  • diet, obesity, lack of exercise, smoking, DM
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13
Q

The activation of what oncogenes/loss of what tumour suppressors can turn an adenoma into a carcinoma?

A

Oncogenes

  • K-ras
  • C-myc

Tumour suppressors

  • APC
  • p53
  • DCC

General DNA repair pathway genes

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14
Q

What are the symptoms/signs of colorectal cancer?

A

Change in bowel habit/continence
Bleeding
Pain (poorly localised)
Non-intestinal manifestations (investigate if >60yo, or 40 if multiple)

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15
Q

What investigations might be done in suspected colorectal cancer?

A

Colonoscopy

  • biopsy/therapeutic (polyp removal)
  • sedation needed, perforation risk

Barium enema
Virtual CT colonography
CT abdo/pelvis

MRI (+ guided colonoscopy)

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16
Q

What is the purpose and method of population screening for colorectal cancer?

A

Detect pre-malignany adenomas early

Faecal occult blood test
Faecal immunochemical test
Endoscopic investigations

Scottish bowel screening programme

  • 50-74yo
  • FOBT every 2 years
  • +FOBT? Colonoscopy
17
Q

How may colorectal cancer be treated?

A

Surgery is basis of therapy ((80% of patients)

  • endoscopic/local resection for minimally invasive cancers
  • stoma formation (permanent or temporary)
  • removal of lymph nodes for histological analysis
  • partial hepatectomy for metastases

Chemo

  • Dukes C and possibly B
  • if +ve lymph node histology
  • 5-fluorouracil

Radiotherapy

  • rectal only
  • with/without chemo to control primary tumour prior to surgery

Palliative for advanced disease

  • chemo
  • colonic stenting
18
Q

What are the various stages of Dukes’ criteria?

A

A - confined to mucosa
B - extended through mucosa to muscle
C - lymph node involvement
D - distant metastases

19
Q

What is the rough prognosis (5YS) for colorectal cancer?

A

Dukes A - 83%

Dukes D - 3%

20
Q

What is bowel anastomosis? What are key aspects to its success?

A

Attachment of two previously distant portions of bowel after resection

Tension free
Well perfused/oxygenated
Clean surgical site
Acceptable systemic state

21
Q

What are risk factors for cholangiocarcinoma?

A 
Primary sclerosing cholangitis
Congenital cystic disease
Biliary-enteric drainage
Thorotrast
Hepatolithiasis
Carcinogens
22
Q

What are the symptoms/signs of cholangiocarcinoma?

A

Obstructive jaundice
Itching
Non-specific symptoms

23
Q

What investigations might be done in suspected cholangiocarcinoma?

A 
Usual lab tests
Radiology
- USS/EUS, CT
- magnetic resonance angiogram
- MRCP/ERCP, FDG-PET, cholangioscopy
24
Q

How is cholangiocarcinoma treated?

A

Surgery only potential curative option
- the only option in intrahepatic cholangiocarcinoma

Surgical bypass
Stenting
Palliative radiotherapy
Chemo
Photodynamic therapy
Liver transplant (not standard)
25
Q

What are the symptoms/signs of hepatocellular carcinoma?

A

Decompensation of liver disease
Abdominal mass/pain
Weight loss
Bleeding (from tumour)

26
Q

What investigations might be done in suspected hepatocellular carcinoma?

A

Tumour markers - AFP
Radiological tests
Liver biopsy done rarely

27
Q

What are the treatment options in hepatocellular carcinoma?

A

Hepatic resection
Liver transplant

Chemotherapy
- local (TACE) or systemic

Ablation
- alcohol, RFA

Sorafenib (TKI)
Tamoxifen

28
Q

What are the different types of oesophageal cancer? Where do they mostly occur?

A

Adenocarcinoma - distal oesophagus

  • obesity
  • GORD, Barrett’s

Sqaumous cell carcinoma

  • Proximal/Middle oesophagus
  • smoking/alcohol
  • low socio-economic status
29
Q

How does oesophageal cancer present?

A 
Progressive dysphagia (90%)
Anorexia/weight loss (75%)
Odynophagia
Chest pain
Cough
Pneumonia
Vocal cord paralysis
Haematemesis

Usually presents late
- have commonly spread to regional nodes/liver

30
Q

What investigations might be done in suspected oesophageal cancer?

A

Endoscopy/biopsy
Staging using CT/EUS/PET/Bone scan

EUS for TN staging
PET CT for M staging

31
Q

What are the treatment options in oesophageal cancer?

A

(Metastatic = unfit for surgery, so palliative care)

Only potential cure is oesophagectomy with/without adjuvant/neoadjuant chemo (5YS 30%)

Require nutritional support

32
Q

What are the risk factors for pancreatic carcinoma?

A

Smoking
Chronic pancreatitis
Adult onset DM
Hereditary

75% are duct cell mucinous adenocarcinomas (pancreas head most common site)

33
Q

Symptoms/signs of pancreatic cancer?

A 
Upper abdominal pain
Painless obstructive jaundice
Weight loss (90%)
Anorexia
Fatigue
Diarrhoea/steatorrhea
Nausa/Vomiting
Tender subcutaneous fat nodules
Ascites, portal hypertension
Diabetes
Recurrent pancreatitis]
34
Q

What might you find on examination of someone with pancreatic cancer?

A 
Hepatomegaly
Jaundice (obstructive)
Andominal mass/tenderness
Ascites/splenomegaly
Supraclavicular lymphadenopathy
Palpable GB (with ampullary carcinoma)

Presence of these (except GB) usually indicate unresectable tumour

35
Q

What investigations might be done in suspected pancreatic cancer?

A

Usual imaging (US, CT, MRI, XR)

Blood test
Laparoscopy + Lap USS
Peritoneal cytology
PET
Tumour markers (CA19-9)

Jaundice - ERCP

Mass with no jaundice
- EUS/percutaneous needle biopsy

36
Q

Treatment options in pancreatic cancer?

A

Majority are advanced at presentation, only 10% operable

Radical surgery

  • Whipple’s (only if fit, tumour <3cm, no mets)
  • PPPD alternative

Palliation of jaundice

  • palliative bypass vs ERCP or PTC stenting
  • duodenal obstruction (bypass vs stent)

Pain control
Chemo

37
Q

What is the prognosis in pancreatic cancer?

A

Inoperable survival <6months (1% 5YS)

Operable 15% 5YS, 30-50% if tumour is ampullary

S2.1 Gastrointestinal (12 decks)

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